US Healthcare Claims Processors

10 Openings

Taguig City

Role description

• Review, investigate, and resolve provider inquiries via the ticketing system (OneHub)
• Assist providers by clarifying payment determinations, claim status, and policy-related queries
• Route or coordinate requests with adjustment/claims team when correction or reprocessing is required
• Analyze claims to determine accurate payment or denial decisions as per policy and benefits
• Apply appropriate benefits, edits, and pricing guidelines, including physician contract pricing
• Maintain thorough documentation and follow up on pending provider requests
• Handle a high volume of repetitive tasks efficiently while maintaining accuracy and compliance
• Continuously improve productivity and achieve required quality and SLA targets
• Adapt quickly to system updates, process changes, and new learning requirements
• Uphold UST values - Integrity, Customer Centric...